AlterPet
Questionaire
The purpose of this questionnaire is to help
AlterPet, Inc. match the right people with the right pet. Animals like people have a
variety of personalities and we want both you and the pet to be comfortable and happy.
Most of the animals here at AlterPet Inc. have either been neglected or abused, and
require love and an adjustment period in a new home. We strive to find a home where the
animal is not only a pet but also a part of your family.
Your
Name(s)________________________________________________________________________________
Address :
____________________________________________________________________________________
Phone #: _________________________ Email Address:
_____________________________________________
Please make sure that your email address is
correct, and that it will accept messages from us. If more information is needed we will
contact you by email, and if it bounces your application will take longer to process. The
longer your application takes to process, the less likely the pet you want to adopt will
still be available.
Drivers License
No._______________________________________
Date of Birth: ______________________
Name,
Address & Phone # of Employer (s):
1.___________________________________________________________________________________________
2.
__________________________________________________________________________________________
Do you have a credit card (s)? Yes _________________ No _________________
If
so, What type? _____________________________________________________
Do
you have children? _____________ If so, what
are their ages? ______________________________________
Will
this be your children's first experience with a pet as part of the household?
____________________________
Does anyone in the household have known allergies
to any animals? Yes _____________ No______________
If
yes, what type of allergy?
_____________________________________________________________________
What would you do if someone in the household
became allergic to the pet after you adopt it?
____________________________________________________________________________________________
____________________________________________________________________________________________
Do you own your home? Yes ____________ * No _______________
·
If
you rent, AlterPet needs written permission or a copy of the lease agreement from your
landlord allowing pets BEFORE you can take an
animal
home
Do
you live in a house with a large yard? _______________
House with a small yard? _________________
Farm?
_______________ Apartment or
Condominium? _____________________
What type of outside containment do you plan to
use? Fenced Yard
____________ Leash ______________
Trolley
Run ____________ Other/ Explain
________________________________________________________
If fenced yard, how high and what type, and how
much of your yard is enclosed?
____________________________________________________________________________________________
Other
pets you currently own?
___________________________________________________________________
If none, have you ever owned pets before? Yes ____________ No _____________
What
kind ? __________________________________________________________________________________
If
yes, what happened to the former pets?
__________________________________________________________
Have
you adopted from a shelter before? Yes
_______________ No
_______________
If
you've adopted from a shelter in the past, how long ago was it?
_______________________________________
Do
you still have the animal you adopted from the shelter?
Yes ______________
No _______________
If
no, what happened to it?
_______________________________________________________________________
Have
you ever taken a previous pet to a shelter?
Yes ________________ No ________________
Why
do you want to adopt a pet?
_________________________________________________________________
____________________________________________________________________________________________
Dogs
can live 15 years or longer. Can you commit to caring for a pet this long? ____________________________
List
anticipated yearly expenses for pet care:
1
Food/treats? ________________________________________________________________________________
2.
Medication? _______________________________________________________________________________
3.
Vet care? _______________________________________________________________________________
Do
you understand that all household pets need to go the veterinarian on a yearly basis for
shots and a checkup?
Yes
________________ No _______________
Who will be responsible for the care and cost of
this animal? ___________________________________________
Are you familiar with heartworms? Yes _______________ No ________________
Do
you plan to have this dog on heartworm medication? Yes
________________ No _____________
Personal
reference (name, address, phone #, relationship)
1.___________________________________________________________________________________________
___________________________________________________________________________________________
2.
__________________________________________________________________________________________
___________________________________________________________________________________________
Name, Address, Phone # of Veterinarian who will
care for this animal:
____________________________________________________________________________________________
How many hours will the animal be left alone daily?
_________________________________________________
Where
will the animal be kept while you are gone during the day?
_______________________________________
Where
will the animal sleep at night?
______________________________________________________________
How
will the animal be cared for while you are gone on vacation?
_______________________________________
____________________________________________________________________________________________
What
method of housebreaking will you use? __________________________________________________
_______________________________________________________________________________________
Are
you familiar with crate training? Yes
_______________ No ________________
Would
you crate train this animal if it were necessary?
Yes _______________ No _______________
If
you need to learn how to housebreak a pet, we will be happy to teach you or provide you
with the name of a professional trainer. Remember ... it takes time and patience, and some
accidents will happen.
I
understand that AlterPet, Inc. requires the above information to insure that the animals
are placed in a good home. I certify that the above information is true and I understand
that AlterPet Inc. will reclaim the animal(s) if they discover that any of the information
is not true or if any part of the adoption contract is violated.
Applicant(s)
Signatures: ________________________________________________________________________
____________________________________________________________________________________________
Date
AlterPet,
Inc. Agent Signature: ___________________________________________________________________
Date